Insulin Deficiency As A Drug Target

Question 1

Diabetes mellitus define

Answer 1

Group of metabolic disorders characterised by persistent high blood sugar

Question 2

% Of NHS annual budget to treating diabetes?

Answer 2

10%

Question 3

Classification of diabetes mellitus:

Answer 3

T1DM
T2DM
Gestational diabetes
Maturity - onset diabetes of the young MODY
Secondary - as a result of another condition e.g CF

Question 4

T1DM is caused by?

Answer 4

-absolute in twin deficiency resulting from destruction of insulin producing beta cells in the pancreatic islets of langerhans

Question 5

Classification of T1DM

Answer 5

Autoimmune- absolute insulin deficiency and presence of antibodies to pancreatic beta cells
Idiopathic - unknown cause, un common form that is that characterised by absence of antibodies

Question 6

Risk factors of T1DM

Answer 6

Genetic susceptibility
European descent- particularly Scandinavian countries
Family history -10%

Question 7

The most common cause of beta cell destruction in T1DM?

Answer 7

Autoimmune

Question 8

Outline path to type 1 diabetes

Answer 8

Stage 1: normal blood sugar
Ab start to attack insulin - producing cells
No symptoms
Stage 2: abnormal blood sugar, Ab cause damage to the pancreas
No symptoms
Stage 3: abnormal blood sugar, symptoms show up, diagnosis

Question 9

Some symptoms that might show up at stage 3 (path to ) T1DM

Answer 9

Excessive thirst
Fatigue
Weight loss
Frequent urination

Question 10

List some clinical features ( with parameters)/ symptom of diabetes AND persistent hyperglycaemia

Answer 10

HbA1c - 48mmol/mol or more
Fasting plasma glucose 7mmol/L or more
Random plasma glucose 11.1mmol/L or more
Plasma glucose of 11.1mmol/L or more 2 hours after OGTT
Asymptomatic: 2x fasting plasma glucose samples >7 mmol

Question 11

OGTT

Answer 11

Oral glucose tolerance test (ingest 75g of glucose)

Question 12

How to diagnose diabetes if patient asymptomatic? Clinical feature/ symptom

Answer 12

2x fasting plasma glucose sample >7mmol/l

Question 13

After diagnosing diabetes, suspect T1DM for adults if:

Answer 13

Have hyperglycaemia and 1 more of:
- ketosis (burning fat for energy instead of glucose)
- rapid weight loss
- age of onset < 50 yrs
- BMI <25
- personal and/or family history of autoimmune disease

Question 14

After diagnosing diabetes, suspect T1DM for child/ young person if:

Answer 14

Hyperglycaemic and features of:
- polyuria ( a lot of urine)
- polydipsia (excessive thirst)
- weight loss
-excessive tiredness

Question 15

Types of insulin for management

Answer 15

Rapid- novorapid
Short acting- actrapid
Intermediate - humulin
Long acting - levemir

Question 16

Cautions for using insulin for management of diabetes

Answer 16

Injectable - not suitable for all
Hypoglycaemia
Driving restrictions may apply

Question 17

Adverse effects for using insulin for management of diabetes

Answer 17

Weight gain
Hypoglycaemia
Lipohypertrophy (lump of fat under skin caused by rapid injection in same place)

Question 18

Mechanism for using insulin for management of diabetes

Answer 18

Stimulates glucose uptake from circulation to tissues
Stimulates glycogen, lipid and protein synthesis and inhibits gluconeogenesis and ketogenesis

Question 19

Measure/parameter for ketosis

Answer 19

Blood ketones > 3mmol/l or ketonuria

Question 20

Measure/parameter for hyperglycaemia

Answer 20

Blood glucose > 11 mmo/l or known DM

Question 21

Measure/parameter for acidosis

Answer 21

HCO3- <15mmol/L and/or venous pH <7.3

Question 22

Aims of fasting blood glucose: levels on walking and before meals

Answer 22

•On waking = 5-7mmol/L
•Before meals = 4-7mmol/L

Question 23

DKA triggers:

Answer 23

Decreased/missed dose of insulin
•Infection/illness
•Undiagnosed/untreated diabetes (may be first presentation)
•Error in drawing up or injecting insulin
•Intentional skipping of insulin doses
•Pregnancy
•MI or stroke

Question 24

DKA presentation

Answer 24

-Polyuria
- polydipsia
- fatigue
- abdominal pain
- nausea, vomiting
- anorexia
- fruity breath from acetone production
- kussmaul breathing

Question 25

Kussmaul breathing

Answer 25

Abnormal breathing pattern characterised by rapid, deep breathing

Question 26

How to manage DKA:

Answer 26

•IV Fluid rehydration – normal saline
•IV insulin – to correct hyperglycaemia and ketonaemia
•Potassium replacement as needed
•Treat underlying cause e.g. infection
•Continue long-acting insulin
•Avoid hypoglycaemia

Question 27

Action to take if patient has hypoglycaemia
= blood glucose <4 mmol/L
AND adult is conscious and can swallow

Answer 27

Give one of following:
170 mls lucozade
200mls fruit juice
150 mls full sugar fizzy drink
5-6 dexto tablets
4 jelly babies

Question 28

Action to take if patient has hypoglycaemia
= blood glucose <4 mmol/L
AND adult is confused/ disorientated and agitated but can swallow

Answer 28

Follow advice of conscious patient
It unable to swallow, consider use of glucagon 1 mg IM

Question 29

Action to take if patient has hypoglycaemia
= blood glucose <4 mmol/L
AND adult is unconscious, severely agitated or having seizures

Answer 29

Check: airway, breathing, circulation. (ABC)
Use recovery position: administer glucagon 1mg IM
Call for ambulance
It in hospital: give iv glucose